Last month, President Obama awarded the Medal of Honor to former Captain William D. Swenson, United States Army, for heroism and gallantry above and beyond the call of duty in the Battle of the Ganjgal Valley on September 8, 2009.

During 6 hours of intense combat, Captain Swenson did everything expected of leaders and more—keeping his ambushed unit fighting effectively, directing available fires, evacuating the wounded, and leading by example in repeatedly risking his personal safety to retrieve wounded Soldiers and Marines, Afghan allies, and fallen comrades.

Captain Will Swenson would tell you that there were many more heroes in the Ganjgal that day.

In the President’s words, “[In] moments like this, Americans like Will remind us of what our country can be at its best—a Nation of citizens who look out for one another; who meet our obligations to one another, not just when it is easy, but also when it’s hard. Maybe, especially when it’s hard.”

Today, less than 1% of our population shoulders the responsibilities of our national defense through their service in uniform, and just over 7% of all living Americans are Veterans. Veterans Day presents the opportunity to ask ourselves, “For their selfless service and willing sacrifice, what do Veterans need and deserve?”

What Veterans deserve is access to high quality and safe healthcare, benefits and servicesthat buoy them against the rigors of military service, education that prepares them fully for their next success, safe and affordable housing, and meaningful and satisfying employment. At VA, we are privileged to deliver on the promises of the American people to those from whom we ask everything.

In the last 5 years, we have enrolled more than two million Veterans into VA healthcare. Since March of this year, we have reduced the backlog in compensation claims from a record high of 611,000 to about 400,000, a decrease of 211,000 claims in 230 days—while increasing the accuracy of claims we process. We will eliminate the backlog in compensation claims in 2015.

We also committed to ending Veterans homelessness in 2015. Between 2009 and 2012, during a period of prolonged economic recovery, we have reduced the number of homeless Veterans by 17%, breaking previous patterns of increased homelessness during difficult economies. More needs to be done, but we have achieved a remarkable reversal. We expect another decrease this year.

Our gratitude for Veterans should not be a one day a year event, but an abiding commitment on every day of every year. There must be no question that this large and powerful country will meet its obligations to them with the same urgency, skill, and determination as it deploys them on critical missions when our Nation calls.

On this Veterans Day, every Veterans Day hereafter, and every day between them, Veterans must know that this Nation will keep Lincoln’s promise to care for those “who shall have borne the battle” and their families.

I am honored to serve with the dedicated people of VA, and we are all privileged to serve with a President who has provided over a 56% increase to our budget requests so we can provide for the 7% of Americans, who are Veterans, what they need, deserve, and have earned. They answered their calls to duty; let us continue to answer ours.

IOM reports provide objective and straightforward advice to decision makers and the public. This site includes IOM reports published after 1998. A complete list of IOM’s publications, from its establishment in 1970 through June 30, 2013, is available as a PDF.

The 2010 opening of the Captain James A. Lovell Federal Health Care Center (FHCC) created a joint entity between the Department of Defense (DoD) and the Department of Veterans Affairs (VA) and replaced two separate centers in North Chicago. VA and DoD leaders envisioned a state-of-the-art facility that would deliver health care to both DoD and VA beneficiaries from northern Illinois to southern Wisconsin, providing service members and veterans seamless access to an expanded array of medical services. The DoD asked the IOM to evaluate whether the Lovell FHCC has improved health care access, quality, and cost for the DoD and the VA, compared with operating separate facilities, and to examine whether patients and health care providers are satisfied with joint VA/DoD delivery of health care.

Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs, issued the following statement in commemoration of Veterans Day.

As we head into the Veterans Day weekend, I know that we all work every single day of the year in an organization that honors and serves those in uniform and those who have previously served our nation. This coming Monday, the nation will take time to also acknowledge the service and sacrifices of our veterans.

There are over 22 million veterans in our country, and regardless of when, where or for how long they served, we are grateful that these men and women raised their right hand to protect and defend the Constitution. There will be plenty of speeches and ceremonies this weekend to express thanks. I just want to add my own small thank you to every veteran — to include those still serving — within the Military Health System.

And I also want to ask all of you in the organization to continue to strive for how we can even better honor and assist veterans in the coming year. In 2014, the size of our veteran population will increase as combat operations in Afghanistan draw to an end and the overall size of our active military force begins to get smaller.

In the coming weeks and months, we need to reflect on what these changes in our force structure and size will demand from us. We need to continue to break new ground in partnership with the Department of Veterans Affairs and in partnership with our civilian colleagues in ways that facilitate care transitions and in ways that best use our collective capabilities to both train our workforce and treat our shared population in a more integrated way.

Caring and serving our veterans is a profound responsibility and moral obligation. I remain grateful for the professional excellence and personal compassion that you bring to this mission every day.

This does not include billions of other dollars wasted during the last three decades, including $2 billion spent on a failed upgrade to the DOD’s existing electronic health-records system.

For a veteran in the disability claims process, these records are critical: They include DOD service and health records needed by the VA to decide veterans’ disability ratings and the compensation they will receive for their injuries. Stacks of paper files — including veterans’ evidence from DOD of their military service and injuries — sit at VA regional offices waiting to be processed instead of being readily accessible in electronic files.

Although Congress repeatedly has demanded an “integrated” and “interoperable” electronic health-records system, neither the DOD nor the VA is able to completely access the other’s electronic records. Meanwhile, each has spent hundreds of millions of dollars on upgrades to its information technology and on attempts to improve interoperability between their systems.

At a July hearing before the House Armed Services Committee and the House Committee on Veterans’ Affairs, Rep. Jeff Miller, R-Fla., said he was disappointed and frustrated by the years of promises and billions of dollars spent without interoperable health records. “The only thing interoperable we get are the litany of excuses flying across both departments every year as to why it has taken so long to get this done,” said Miller, the chairman of the Veterans Affairs Committee.

The National Defense Authorization Act for 2008 mandated that the DOD and VA secretaries “develop and implement electronic health-record systems or capabilities that allow for full interoperability of personal health information between the Department of Defense and the Department of Veterans Affairs.”

In 2011, the DOD and VA decided the solution would be to create a single electronic healthcare record together. But after two years and more than $1 billion spent on a single, joint integrated electronic health record between the DOD and VA, the department’s two secretaries in February canceled the plan with little explanation.

“It’s frustrating. It’s been inefficient for service members to have to hand-deliver records from one system to another when they get out of the military,” then-Defense Secretary Leon Panetta said at the time. “It doesn’t make a hell of a lot of sense.”

Instead of a joint system, Panetta said the two agencies would upgrade their own electronic health-record systems and build software that would allow the two systems to talk with each other to exchange files. “As President (Barack) Obama directed in 2009, we can and we must do better.”

Panetta said the new direction would allow the departments to meet the president’s goal and do it for a lower cost. But records show the cost may not be lower.

Meanwhile, the VA has moved to invest $12 billion over five years on an entirely new project called Transformation Twenty-One Total Technology, or T4, to upgrade its own technologies. Those upgrades are supposed to include interoperable software that can be used between the VA and DOD.

According to contract data gathered by News21, the VA began paying companies for the project in July 2011, at the same time money still was still being spent by both the DOD and VA on the single, joint health care records system.

In fact, one of the VA’s contractors, Harris Corp., has a multiyear contract with the VA worth $80.3 million to create software allowing the two departments’ systems to communicate with each other, a deal that was signed almost a year before the DOD and VA gave up on a single electronic health record.

The DOD also is looking for a replacement for its health record system. The 2014 DOD budget requests $466.9 million for “initial outfitting” and “replacement and modernization” of its current health care record.

Sen. Patty Murray, D-Wash., a member of the Committee on Veterans’ Affairs, told News21 in an email statement that she is concerned about the future of electronic health records shared between DOD and VA.

“While it is not easy to get the government’s two largest bureaucracies to work together efficiently, I have been very troubled about the effort to develop systems to allow communication between VA and DOD’s medical records,” she said. “I am especially concerned DOD spent hundreds of millions of tax dollars — and thousands of staff hours over the last few years — trying to create an integrated IT platform with the VA only to announce they were unable to come to a solution.”

For a disability claim to be processed in 125 days, a goal outlined in a Jan. 25 VA report, the files must be electronic, which means all paper records must be scanned into the system.

The VA scanning system — Veterans Benefits Management System (VBMS) — cost $480 million between 2009 and 2012, yet the VA never set deadlines for the records to be scanned. As of early July, only about 30 percent of paper claims had been scanned — that’s 165 million pieces of paper, according to the VA.

That represents about one-third of the entire paper workload, which does not include the estimated 26,000 service members who will make their way home within the next year from Afghanistan. Nor does it include veterans who have yet to file disability claims.

Those pieces of paper can make or break a veteran’s chance of getting the correct disability compensation. The compensation can help offset costs such as rent and car payments for those who may not be able to work because of issues they suffer, such as post-traumatic stress disorder or chronic back pain. All are common among veterans who served in Iraq and Afghanistan.

In 2012, the average time a claim waited for evidence to be processed — which includes those health and service records from DOD as well as physical exams — was 206.7 days, according to Veterans Benefits Administration documents. Gathering evidence is the longest part of the claims process.

DOD health records make their way to the VA within 45 days, DOD spokeswoman Cynthia O. Smith told News21 in an email. She wrote that, although the records are available electronically on request, all DOD records are transferred on paper to the VA. Yet, DOD Undersecretary of Defense for Acquisition, Technology and Logistics Frank Kendall contradicted her, saying most records are transferred electronically.

The VA did not say how it receives records from the DOD.

The National Defense Authorization Act for 2008 also called for the creation of an agency to fix the interoperability problems between the VA and DOD. The Interagency Program Office was established as the “single point of accountability” between the two departments.

Debbie Filippi, the first director of the office, said restrictions from the VA and DOD, as well as a minimal budget, kept the office from making progress during her two-year tenure. “It takes time to turn an aircraft carrier,” she said.

Filippi retired in 2011, before this February’s cancellation of the joint electronic health-record project. “The hope had fizzled out and then re-gathered,” she said. “And then it broke apart again.”

In March, Allison Hickey, undersecretary of the Veterans Benefits Administration, told members of Congress there is an agreement in place requiring the DOD to provide “100-percent-complete service treatment and personnel records in an electronic, searchable format.”

The VBA estimates such a move would cut the claims backlog time by anywhere from 60 to 90 days.

An amendment to the 2014 National Defense Authorization Act, proposed by Rep. Ann Kirkpatrick, D-Ariz., would require the DOD to provide complete service treatment records to the VA within 90 days of a service member leaving the military. “No doubt in my mind our veterans will be better served by an electronic system,” Kirkpatrick told News21.

The Janus Joint Legacy Viewer, a cloud-based medical records system that allows DOD and VA medical records to be displayed on one screen, launched at nine sites in July. David Waltman, the VA’s chief user experience architect of the integrated electronic health record, said the department is exploring the use of the Janus Joint Legacy Viewer to help in the claims process. He said it will ultimately be tested at regional offices this year, but only two employees at each office will have training and access.

Rep. Phil Roe, R-Tenn., in May introduced legislation requiring the VA and DOD to revive plans for the single, integrated health record system. “You don’t spend a billion dollars and say we can’t do it,” Roe told News21 in a phone interview.

“This is one we have to get right,” he said. “Not for my generation, but for future soldiers I don’t even know.”

The Department of Veterans Affairs (VA) and the Department of Defense (DoD) Joint Executive Committee (JEC) Joint Strategic Plan (JSP) is the primary source document that conveys to the Secretaries of the Departments the JEC’s recommendations for the strategic direction of joint coordination and sharing efforts between the two Departments. Co-Chaired by the Deputy Secretary of Veterans Affairs and the Under Secretary of Defense for Personnel and Readiness, the JEC manages and implements the joint priorities monitored by the Secretaries of both Departments.

The following is an excerpt from Section 734 of H.R. 1960 – pending National Defense Authorization Act 2014 legislation, page 399.

SEC. 734. INTEGRATED ELECTRONIC HEALTH RECORD OF THE DEPARTMENTS OF DEFENSE AND VETERANS AFFAIRS.

(a) SENSE OF CONGRESS.—It is the sense of Congress that—

(1) despite repeated attempts at cooperation over the past 20 years, the Department of Defense and the Department of Veterans Affairs have failed to implement a solution that allows for seamless electronic sharing of medical health care data;

(2) the recent decision by the Secretary of Defense and the Secretary of Veterans Affairs to abandon their earlier agreement and pursue separate paths to integration jeopardizes the stated goal of providing ‘‘a patient-centered health care system that delivers excellent quality, access, satisfaction, and value, consistently across the Departments’’;

(3) despite the repeated concerns and objections of the congressional committees of jurisdiction, the Department of Defense and the Department of Veterans Affairs seem to be on a continued path to fail in achieving the goal of creating a seamless health record that integrates data across the Departments; and

(4) the President should make the necessary leadership changes to assure timely completion of this requirement.

(b) IMPLEMENTATION.—The Secretary of Defense and the Secretary of Veterans Affairs shall—

(1) implement an integrated electronic health record to be used by each of the Secretaries; and
(2) deploy such record by not later than October 1, 2016.
(c) DESIGN PRINCIPLES.—The integrated electronic health record established under subsection
(b) shall adhere to the following principles:

(1) To the extent practicable, efforts to establish such record shall be based on objectives, activities, and milestones established by the Joint Executive Committee Joint Strategic Plan Fiscal Years 2013–2015, including any requirements, definition,documents, or analyses previously developed to satisfy said Joint Strategic Plan.

(2) Principles with respect to open architecture standards, including—

(A) modular designs based on standards with loose coupling and high cohesion that allow for independent acquisition of system components;

(B) if existing national standards do not exist as of the date on which the record is being established, the Secretaries shall agree upon and adopt a standard for purposes of the record until such time as national standards are established;